Inept public health sector is a death trap

Coffin makers don’t necessarily pray that people die so that they sell their wares. But they are happy to receive orders. The same applies to doctors. Their advice on how to stay healthy and keep the doctor away to a certain degree is a prayer to render themselves redundant. But they nevertheless will receive patients and if payment is per head, the more the merrier.

It is reasonably said if you do something well, make sure you get paid for it. So if you treat people and they get better or even if they don’t because most probably it is their time despite your best effort as a doctor, it is okay to charge and be paid. The next issue is what should be paid and how do we get to that amount. The period before 1993 when cost-sharing was introduced in the Uganda healthcare system, most of us were treated in government and missionary hospitals. 

I recall as a boy visiting a dentist; a one Dr Adoo (RIP) and also seeing Dr Otiti, an Opthamologist at Mulago Hospital. The environment was nice and clean and I always looked forward to going back to the hospital. Many years later, cost-sharing was introduced as one of the conditions of the World Bank as part of the structural and sectoral adjustment measures. 

The patients, majority of who live on less than a dollar a day, would have to share part of their health bills with the government. The later would mainly bring in the infrastructure needed expensive cancer machines and the former pay user fees to maintain them. The government would also be in charge of regulating and ensuring that healthcare providers did the right thing of keeping the citizen healthy at a minimal cost with the proper treatment regimens.

It all sounded logical, but ran into trouble when it came to actualising it. The government’s ever decreasing health budgets, increasing population, emigration of medical personnel to the so-called greener pastures where their services would be paid better, gradually saw the government hospital as we knew it turning into a hospice.

Nature does not tolerate vacuums. In came commercial medicine with a vengeance. Most doctors stayed with government facilities and at the same time had a private clinic or sold their skills to several of them on the side. It was now the market forces of demand and supply at play. The private clinics or hospitals being better paying, saw a practice of doctors in government hospitals referring patients to private clinics and pharmacies some of which they operated. 

Before long, came the investor. Investors by nature are not the legendary mother goose that fends for its young ones. They are into medicare as a business, the viability of which depends on mimising cost to maximise profits. 
Some of the measures include hiring inexperienced young doctors who may be underpaid and overworked. Many have been overwhelmed by complicated cases leading to fatalities.
Insisting on patients consuming drugs that are available in the pharmacy owned by the hospital even if they are not the most effective for the condition. Also taking tests in labs in their premises or of their choice irrespective of their dexterity. 

You should hear the tales. Let’s just take three. At the weekend, a lady collapsed and was rushed to one of the private hospitals. She was tested for the liver, kidney and a few other routine tests while she was being hydrated. Her organs started shutting down and was placed on life support. Less than 24 hours later, she was pronounced dead. 
The family accepted her fate, but were taken aback by the Shs10m bill that followed. One of the items inserted in an attempt to justify the ginormous bill was even more flabbergasting, a whopping 50 injections administered in less than 24 hours! All monies to be paid before release of the body.

There was the case of the busy gynaecologist, who was on high demand and worked in several clinics. He decided on a caesarean section for a lady who reportedly was not due because he had to go to another clinic and did not want to miss out on the pay for delivering in both places. C-sections are more paying apparently.
 She almost passed on because he left her immediately after the procedure and she bled profusely. Another doctor had to help her as busy doctor was already in a theater elsewhere carrying out another c-section.

We also heard about the hospital that was handling a patient who was terminally ill and kept on charging for treatment in the intensive care unit (ICU) per night.
When the condition of the patient deteriorated they referred them to a Missionary hospital where they learnt that the facility from which they were referred did not at any one time own or operate an ICU. The reason for the referral was to get the patient into an ICU!

On this page some time ago, Dr Munini K Mulera once told us about a shady scheme in which doctors are paid to refer patients to India even when their chances of survival are zilch.  There are others where big pharma motivates doctors with the aim of encouraging them to prescribe or even test their drugs on patients. We need to ask if the government is regulating the privates and keeping statistics of those who die in these facilities plus the remedial measures taken when they are found wanting. Or it is every man for himself and God for us all.
An inept public health sector is a death trap. But an unregulated marketplace is definitely not the panacea in the long-run.